Permit A „ CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00658
40 DEVELOPMENT SERVICES DATE ISSUED: 10/13/2004
I
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S 101 AC -01300
SITE ADDRESS: 07105 SW HAMPTON ST
SUBDIVISION: BEVELAND NO. 2 ZONING: MUE
BLOCK: LOT : 018 JURISDICTION: TIG
Project Description: Rework existing receptacle in new reception desk.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp:. EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KAISER FOUNDATION HEALTH OREGON ELECTRIC CONST /GROUP
PLAN OF THE NORTHWEST #838 1010 SE 11TH AVE
ATTN: PROPERTY ACCOUNTING PORTLAND, OR 97214
PORTLAND, OR 97227
Phone: Phone: 503 - 535 - 2652
Reg #: LIC 203
SUP 4460S
FEES EL 26 -95C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 10/13/200' $53.50
[TAX] 8% State Surcharge 10/13/200' $4.28 Rough -in
Elect'l Final
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Issued By:� Permit Signature: \( ),1
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
OCT -12-04 02:09PM FROM - Oregon Electric Estimating 5032313587 T -692 P.001 /002 F -697
J2 AGI.Ll 1LA1 1 VA MIL L1111Jp AAVLL t.AVIUI I i f
City of l'i and Received n ,/ I , /
g � c� � L�-� �® Doe y, , tl 1 3 -- Perm No.! L�J <
i3 1 i S W Hall Blvd., Tigard, OR V Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4 : ' 1iil}'Ii �`� Date/By: Other Permit:
•
Inspection Line: 503.639.4175 2 21:10 ,, Date Ready/By: luris. H See Page 2 for
Internet: www.ci.tigard.or.us ( J
OCT Notified/Method: j I G" Supplemental lnfurmn6nn
Q .RrO � PLAN REVIEW. •
• d Ncw construction ®- tti, :• fl( 1te$att u laCernent Please check all that apply:
CI Demolition 11] Other, ['Service over 225 amps, comm'l ['Hazardous location
CI Service over 320 s rats Buildng over 10,000 sq f
ama'- ng 0 ft.,
t.
CAT) GORY' OR , COP1S R'uc ION;. of 1 -and 2- family dwellings 4 or more new residential
•
❑ 1- and 2- family dwelling ® Commercial/industrial 0 Accessory building ❑System over 600 volts nominal units in one structure
El Multi- family ❑ Master builder ❑ Other: ['Building over three stories ❑Feeders, 400 amps or
(]Occupant load over 99 persons ['Manufactured structures or
JOB • SITE IINFORMATION•: AND :LO.CATION >' ' ❑Egress/lighting plan RV park
Job no.: 19985 Job site address: 7105 SW Hampton St ❑Itealth -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.; Project name: Kaiser Permanente Tigard Dental FEE" SCHEDULE:
Description Qty. Fen Total
Cross street/directions to job site: New residential Singh or multi - family dwelling unit.
Includes attached garage.
1,000 sq. it. or less 145.15 4
Subdivision: Lot no.: Ea- add') 500 sq. ft or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
i r • ;DESCRIPTION OF WORK,..:... .... • . • Each manufactured or modular
Rework existing receptacle in new reception desk. dwelling, service and/or feeder 90,90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROP Ow TB:. . i ' �-:' ; .. aTENASIT; : 201 amps to 400 amps 106.85 2
• 401 amps to 600 amps 160.60 2
Name: Kaiser Permanente Tigard Dental 601 amps to 1,000 amps 240.60 2
Address: same Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: (503)682-9274 f l=ax: ( ) relocation
200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits- new, alteration, nr extension, per panel
El APPLIGgNT , 1 . . , ❑ CONTACT .PERSON . A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: - B. Fee for branch circuits
without Service or feeder fee, / 46,85 2
each branch circuit
Address: Each addl branch circuit / 6.65 2
City /Stare/ZIP: Miscellaneous (service or feeder not included)
Pump Or irrigation circle 53.40 2
Phone: ( ) I Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
.. • • • • ;' .CONTRACTOR• •'. I .. ''l . , energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Oregon Electric Group
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Portland, OR 97214 Investigation per hour (I hr min) 62.50
Phone: (503) 535 -2652 I Fax: (503) 231 - 3587 Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES*
SSU CCB Lie.: 203 I Electrical Lic.: -• S p Lie.: 44605 Subtotal
Suprv. lectriciansi signature, required: /� i - J�
bin i Q ' �i�� Plan review (25% of permit fee)
�/ (� St surcharge (8% of permit fee)
Print name: i/4. ; „v� b sate: � 7.46
01 - - TOTAL PERMIT FEE s--7, 7
Authorized Signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted CS complete •
Print name: i IC / / / ._ Date: • Fee methodology set by t ri Coun x Buildin industry ervice Board
Af / d " •' Number of inspections per permit allowed. m
i.\Suilding\Yernms1 EEC- PennikApp,doc 15/03 440 -6I sr( to /0JCOM/wEB
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / — 7 AM PM BUP
Location S - .re/4A .441sviit _% ' Suite MEC
Contact Person j / ' Ph ( ) PLM
Contractor 6 - Ph ( ) �' 1 a g SWR
BUILDING Tenant/Owner 4 JLPA J ELC 06•__24528
Footing
ELC
Foundation
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P ASS PART FAIL � ,
PLUMBING
Post & Beam V
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECT RICA L
Service
Rough -In
UG/Slab s 5
Low Voltage
Fire Alarm
na Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
AS PART FAIL
SITE 0 Please call for rein pection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record rom the b site:
PASS PART FAIL